A Case Control Study to Assess the Risk Factors for Preterm Deliveries Among the Mothers Admitted in Shri Vinoba Bhave Civil Hospital, Silvassa, Dadra and Nagar Haveli

BACKGROUND: According to WHO Preterm delivery is defined as a delivery that occurs before 37 weeks of gestation. “Born too Soon” decade of action on preterm birth, produced by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) together with PMNCH-the world’s largest alliance for Women, Children, and adolescents sounds the alarm on a “Silent emergency” of preterm birth, long under recognized in its scale and severity which is impeding progress in improving children’s health and survival. OBJECTIVE: This study aim to determine the risk factors associate with preterm deliveries among the Mothers admitted in Shri Vinoba Bhave Civil Hospital, Silvassa, Dadra and Nagar Haveli. METHODS: The research design adopted for study was Case-control study. The written permission was obtained from the concerned authority of Shri Vinoba Bhave Civil Hospital, Silvassa for conducting the study. During the data collection period, the investigator established a good rapport with Mothers who had participated in the study and taken written consent from each of them. Samples were assigned using consecutive sampling technique. As per the research design & tool, demographic & maternal related data was collected. After collecting data from 200 samples for control group and 50 samples for case group were analysed using descriptive and inferential statistics. RESULT: A family history of PTD (OR:2.1, p value: 0.001, CI: 0.897-6.610), Height (OR: 1.672, p Value:


Null Hypothesis (H0):
There is no association between the socio-demographic and maternal variables with Preterm deliveries.

Research Hypothesis (H1):
There is significant association between socio-demographic and maternal variables with Preterm deliveries.

ASSUMPTIONS:
1. Mothers' exposure to risk factors may lead to preterm birth.2. Demographic Variables may influence preterm birth among the Mothers.

RESEARCH DESIGN/METHOD:
The research design used in the present study for assessing the risk factors for preterm deliveries among the mothers at Shri Vinoba Bhave civil hospital, silvassa, DNH was case control (analytic) observational study design as the data from the mothers were collected from past through case records and structured interview method.After that assess the risk factors for preterm deliveries.In the present study, the samples were divided into two groups, case group and control group.For every case records 4 control group records were obtained.The control group were type of delivery matched.Case Group comprised of 50 samples.Control Group comprised of 200 samples.Consecutive sampling technique was used in present study.

VARIABLES: Inclusion Criteria:
For case group: • All Primi mothers who are delivered alive pre-term babies (under 37 weeks) gestational age in the Shri Vinoba Bhave Civil Hospital, Silvassa and DNH were included for this study.• All mothers who speak in Hindi, Gujarati, and English.
• All Primi mothers who are local residence of DNH.For control Group: • All Primi mothers who are delivered alive term babies (between 37 to 42 weeks) gestational age in the Shri Vinoba Bhave Civil Hospital, Silvassa and DNH were included for this study.• All the mothers who speaks in Hindi, Gujarati, and English.
• All Primi mothers who are local residence of DNH.Exclusion Criteria: • The Mothers of the newborn babies who did not provide consent were excluded.
• Incomplete files without phone numbers and contact information, unknown pregnancy age, incomplete medical records.• Those mothers with unknown LMP or absent in registration and investigation.
• The mother who having a twin pregnancy, IUFD.

DATA COLLECTION TOOLS AND TECHNIQUE: STRUCTURED INTERVIEW METHOD AND CASE RECORDS
The tool consists of three sections: Section A: Demographic Performa Section B: Bio physiological Profile  This table shows that Education of mother, Education of father, Occupation of mother, Occupation of father, total capita family income per month, religion, family history of other disease, marital status, types of family and source of antenatal care regarding information does not have any association between Case Group and control Group.Other significant data such as Family history of preterm Birth and Place of residence does have significant association between Case Group and Control Group.Hence stated hypothesis there will be association between the socio-demographic and maternal variables with pre-term delivery was accepted at 0.05 level of significance.
In Univariate analysis, A mother's with Family History of preterm birth (OR: 4.47, CI: 0.09-0.37,P< 0.0001) were 4 times more chance to give preterm birth than those who had no family history of preterm birth.
A mothers who residing in rural area (OR: 5.63, CI: 2.14-14.82,p<0.001) were 5 times more chance to give preterm birth than those who residing in Urban area.

This table shows that, (Chi-square test)
The chi-square value for height (20.979) was higher than the table values (3.84) found that there is a significant association between preterm delivery and height.The chi-square value for Body Mass Index (15.3163) was higher than the table values (7.82) found there is a significant association between preterm delivery and BMI.The chi-square value for weight gain during pregnancy (30.99) was higher than the table value (5.99) found there is a significant association between preterm birth and weight gain during pregnancy.The chi-square value for at birth BP of mother (4.201) was higher than the table value (3.84) found that there is significant association between preterm delivery and BP of mother.The chi-square value for hemoglobin level of mother (12.36) was higher than the table value (7.82) found that there is significant association between preterm delivery and hemoglobin level.The chi-square value for third trimester NST (25.72) was higher than the table value (5.99) found that there is significant association between preterm delivery and third trimester NST.Hence, stated hypothesis was accepted at 0.05 level of significance.
The table shows that calculated Chi-square values for Prepregnancy BP of mother, gender of neonates, and current Sero status of mothers were less than the table values found that there is no significant association between preterm birth and Biophysiological profile.Hence stated hypothesis was rejected at 0.05 level of significance.

This table shows that, (Odd ratio)
A mothers who belong to <150 cm height group (OR: 4.47, p=0.00001, 95% CI: 1.96-8.78)were having 4 times more chance to deliver preterm baby than those who belong to ≤150 cm.A mothers who were having underweight and obese (OR:3.52,P=0.0001, CI:) were having 3 times more chance to give preterm birth than those who were healthy.
A mothers who gain weight < 10 kg during pregnancy (OR: 7.95) were having 7 times more chance to deliver preterm baby than those who gain weight more than 10 kg.The Chi-square values for maternal urine analysis (7.68) were higher than table value (3.84) found that there is significant association between preterm deliveries and maternal urine analysis.The Chi-square value for iron and folic acid tablet consumption (20.57) were higher than table value (3.84) found that there is significant association between preterm deliveries and IFA tablets.The Chi-Square value for started time of IFA tablet consumption (7.987) was higher than table value (7.82) found that there is significant association between preterm deliveries and started time.
The Chi-square value for Danger signs and symptoms during pregnancy (14.24) were higher than table value (3.84) found that there is significant association between preterm deliveries and Danger signs and symptoms during pregnancy.The Chi-square value for Anti-helmintic treatment (44.76) was higher than table value (3.84) found that there is significant association between preterm deliveries and anti-helmintic treatment.
The table shows that calculated Chi-square values for tetanus toxoid vaccine, check blood measurements, History of previous abortion were less than the table values found that there is no significant association between preterm birth and Biophysiological profile.Hence stated hypothesis was rejected at 0.05 level of significance.

This table shows that (Odd ratio test)
Mother who are not attending the OPD of antenatal clinic or only 1 to 2 times visit (OR: 4.20, P<0.001, 95% CI) were having 4 times more chances to deliver preterm deliveries than those who are taking regular visit.Mothers who were having danger sign and symptoms during pregnancy (OR: 3.30, P<0.001, 95% CI: 1.74, 6.25) were having 3 times more chances to deliver preterm deliveries than those who were having no sign and symptoms.The Chi-square value for presence of maternal medical variables (20.766) was higher than table value (3.84) found that there is significant association between preterm deliveries and maternal medical variables.

Maternal Medical Variables
The Chi-square value for Hypertension (4.1329) was higher than table value (3.84) found that there is significant association between preterm deliveries and hypertension.The Chi-square value for presence of anemia (10.016) was higher than table value (3.84) found that there is significant association between preterm deliveries and presence of anemia.The Chi-square value for presence of maternal infection (4.6596) was higher than table value (3.84) found that there is significant association between preterm deliveries and presence of maternal infection.
The table shows that calculated Chi-square values for diabetes mellitus, UTI, asthma, malaria, dengue, history of COVID-19, Sickle cell disease, typhoid fever that there are no significant association between preterm birth and Biophysiological profile.Hence stated hypothesis was rejected at 0.05 level of significance.

This table shows that (Odd ratio test)
Mother who are having maternal medical conditions (OR: 3.59, P<0.001, 95% CI: 2.657-6.784)were having 3 times more chances to deliver preterm deliveries than those who are not having medical conditions.Mothers who are having hypertension (OR: 8.The Chi-square value for presence of obstetrical complications (13.9562) was higher than table value (3.84) found that there is significant association between preterm deliveries and maternal obstetrical complications.
The Chi-square value for presence of oligohydramnions (5.793) was higher than table value (3.84) found that there is significant association between preterm deliveries and oligohydramnions.The Chi-square value for presence of PROM (18.6012) was higher than table value (3.84) found that there is significant association between preterm deliveries and PROM.The Chi-square value placenta location (6.09) was higher than table value (3.84) found that there is significant association between preterm deliveries and placenta location.
The table shows that calculated Chi-square values for Ante partum Hemorrahge, Polyhydramnions, Obstructed labour, Pre-eclampsia, CPD, Fetal Distress that there are no significant association between preterm birth and maternal obstetrical variables Hence stated hypothesis was rejected at 0.05 level of significance.

This table shows that (Chi-Square test)
The Chi-square value for any stressful event occurs during pregnancy (11.72) was higher than table value (3.84) found that there is significant association between preterm deliveries and stressful event occur during pregnancy.The Chi-square value for bad habits (5.859) was higher than table value (3.84) found that there is significant association between preterm deliveries and bad habits.
The Chi-square value for presence of psychological violence (11.91) was higher than table value (3.84) found that there is significant association between preterm deliveries and psychological violence.
The table shows that calculated Chi-square values for physiological violence, rest during a day, and meals per day, there are no significant association between preterm birth and lifestyle, behavioural and IPV related maternal variables Hence stated hypothesis was rejected at 0.05 level of significance. This

. When did you start IFA tablet?
If third trimester NST more non-reactive (OR: 5.23, 95% CI:2.65 -10.29,P<0.01) were having 5 times more chances to deliver preterm baby.The Chi-Square values for Ante natal visit (19.7368) were higher than table value (3.84.) found that there is significant association between preterm deliveries and antenatal visit.

table shows that (Odd ratio test)
Mother who are having stressful event during pregnancy (OR: 3.047, P=0.001, 95% CI: 1.58-5.86)were having 3 times more chances to deliver preterm deliveries than those who are not having stressful event during pregnancy.Mother who are having bad habits (OR: 4.33, P=0.015, 95% CI: 1.20-15.61)were having 44 times more chances to deliver preterm deliveries than those who are not having bad habits.Mother who are having psychological violence (OR: 11, P=0.001, 95% CI: 2.06-58.52)were having 11 times more chances to deliver preterm deliveries than those who are not having psychological violence.